Can I Avoid IVF Despite Having Polycystic Ovarian Syndrome (PCOS)?
Assisted fertility treatments contribute to almost 2-3% of the total live births in the UK each year. A large proportion of the births is due to in vitro fertilisation or IVF. Despite the increasing use of such treatments and improved safety, they are not without complications.
Some of these are ovarian hyperstimulation syndrome, many pregnancies, miscarriage, ectopic pregnancy, etc. The ovarian hyperstimulation syndrome or OHSS tends to occur more in patients with Polycystic ovarian syndrome or PCOS.
Insulin resistance and hormonal imbalance cause PCOS. This imbalance results in the predominant effect of androgens or male hormones. The androgens prevent the proper development of the follicle and ovulation each month. This also affects the response to fertility stimulation drugs that are used in an IVF treatment.
The changes in the body during an IVF treatment in patients with PCOS expose them to a higher risk of ovarian hyperstimulation syndrome or OHSS. OHSS is managed with safety, but sometimes it can be serious.
Do you have PCOS and are experiencing difficulties in trying to conceive? Then you should discuss your options with a fertility specialist. There are certain interventions that you and your fertility specialist can consider. The interventions may help you avoid an IVF treatment. These include weight management, Ovulation Induction and Ovarian Drilling.
Do you suffer from infrequent ovulation and have a high body mass index (BMI)? Do you also wish to avoid IVF treatment?
Losing even as little as 5% of the current body weight can result in regular ovulation. Once you have reached this state, you can try to conceive in a natural way for a year before considering fertility treatments.
This will also help you in avoiding the risks and complications of an IVF treatment. Also, the restrictions on the availability of NHS funding for IVF treatments are increasing. That is why your consultant gynaecologist at your local NHS Hospital may consider Ovulation Induction and Ovarian drilling.
Ovulation Induction
It is not uncommon to find patients moving to IVF without having tried ovulation induction. Some patients had only a half-hearted attempt at Ovulation Induction. It is much simpler and less risky than IVF. If the ovulation can take place, then the chance of conceiving each cycle is around 15-20%.
This does not take into consideration other factors that may affect your chances such as age. Ovulation Induction can be done using pills, such as clomid or clomiphene. Gonadotropin injections, such as Gonal F or Menopur are also an option. Are you using clomid or clomiphene? Then it is important that your consultant gynaecologist monitors you and identifies your correct dose.
It is important to ensure that only a few follicles are developing. Development of many follicles can lead to many pregnancies such as twins or higher order. Rarely, some women may be resistant to clomid or clomiphene. These women may have to consider taking Gonadotropin injections.
Ovarian Drilling
Some women with PCOS are resistant to clomiphene. Ovarian drilling can correct the hormone imbalance. This can restore ovulation and help you try to conceive in a natural way for the next 6-9 months. Done under general anaesthesia, this is a keyhole day surgery procedure. While it does have the risks of any keyhole surgery, it enables you to get pregnant in a natural way.
Some women, despite ovarian drilling, may be unsuccessful. In such a situation, going through IVF may be the only option.
Weight Management
Many women with PCOS experience difficulties in managing weight. This is a combination of insulin resistance, a possible lower metabolic rate, disordered appetite control or feeling of satiety. The insulin resistance leads to more androgen secretion. This also results in an increased conversion of blood sugar to fat.
The hormones that control appetite or sense of fullness may be produced in a disorderly manner. This means that women with PCOS may not experience a sense of fullness despite the intake of allowance of calories. Given these factors, they may also face difficulties in managing weight.
